Health & Fit Large study of heart stenting vs. surgery sparks controversy

00:05  01 january  2020
00:05  01 january  2020 Source:   reuters.com

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Heart stent surgery is now more common than heart bypass surgery for coronary heart disease. Learn about safety issues and success rates for the procedure. The Basics on Heart Stent Surgery Safety. The majority of angioplasty procedures now include stent surgery .

Why are stents chosen over open heart surgery in younger people and visa versa I don't understand. I had a four way quad and I am great ..I think I would be more nervous with stents in me ..and from my conversation groups in ''Mended hearts ' other stent patients are more anxious than I am .I am

A dispute over how to define a heart attack has prompted some European doctors to back away from the findings of a major study that concluded bypass surgery and stents are equally good at preventing heart disease deaths when a major heart artery is clogged.

Stents - tubes that reopen a narrowed artery - have become increasingly popular because patients recover faster than after surgery. But questions have lingered over whether stenting is as effective as bypass surgery over the long term when the left main coronary artery is blocked.

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Angioplasty/ Stents vs Open Heart Surgery and Effects of Plavix. I also had a sleep study and was found to have sleep apnea so I got CPAP. After I had CPAP, I had much less trouble with the night time reflux.

Stent vs . Surgery . The patients who took part in the study were treated at 29 hospitals around the U.S. All were considered at increased risk for complications with surgery because of advanced age (over 80), co-morbid conditions ( heart failure, advanced coronary artery disease, lung disease) or a

The study, known as EXCEL, followed nearly 1,900 volunteers for five years. As reported in The New England Journal of Medicine in September, the overall death rate was higher with stents (13%) than with surgery (9.9%). But when researchers looked only at deaths from heart disease, the procedures were equally safe. Rates of heart attack were also similar with stenting and surgery.

The new controversy, sparked by a report on the British TV program BBC Newsnight, stems from EXCEL results published in 2016, when patients had been followed for three years.

At the time, the EXCEL authors had similarly concluded the two procedures seemed equally effective. In 2018, using those findings and results from other studies, two major medical organizations changed their guidelines: the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC).

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In asymptomatic patients, carotid artery stenting (CAS) more than doubles the risk of postoperative stroke or in-hospital death compared with carotid endarterectomy (CEA), reports a retrospective study published online November 25, 2014, ahead of print in Stroke.

Using drug-coated stents compares more favorably to bypass surgery in some heart patients with difficult-to-treat clogged arteries when economics and quality of life are The benefits of stenting procedures were more pronounced for patients with less complex coronary disease, a study found.

But on Dec. 9, BBC Newsnight said data leaked from EXCEL shows that if something called the "Universal Definition" is used to define a heart attack, stent recipients are 80% more likely to have one.

Instead of the universal definition, EXCEL researchers used a popular standard for defining a heart attack developed by the Society for Cardiovascular Angiography and Interventions.

The BBC's reporting prompted EACTS secretary general Domenico Pagano to say, "some results in the EXCEL trial appear to have been concealed." The association subsequently advised doctors to disregard the updated guidelines for such patients.

In contrast, the ESC stood by its new guidelines, emphasizing they were based on more than the EXCEL results.

Everyone involved in EXCEL, including surgeons who do cardiac bypass, felt the Universal Definition "was not suitable" for comparing the two techniques, according to the response from the EXCEL team. For example, it defines heart attacks differently in stent and bypass patients, making comparison of the procedures difficult.

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Researchers found slightly more heart patients survived at least five years after bypass surgery - 74 percent, versus 72 percent of those who had a stenting procedure, known as angioplasty. However, people who had no diabetes or heart failure and were non-smokers tended to have better outcomes

The larger question, of course, is not just which type of stent to use. It is, “What are the relative advantages and disadvantages of the various Omer Aziz and colleagues examine the clinical effectiveness of surgery versus stenting for isolated left anterior descending artery lesions (doi

Also, the Universal Definition employs a highly-sensitive blood test to look for damage to heart muscle, a test so sensitive it may detect minor damage inflicted simply by the procedure itself. Many doctors don't even do the test on patients undergoing stenting or bypass surgery.

The higher death rate in the stent group was largely due to causes not heart-related, particularly cancer and infections that appeared several years after stenting or surgery, the EXCEL researchers said.

"There was absolutely no attempt to hide meaningful data," the researchers said, and EACTS withdrew from the guidelines "without so much as even asking the EXCEL study group for clarification."

The researchers also said that because data needed to assess heart attacks under the Universal Definition were not consistently collected from patients in the study, any data leaked to the BBC claiming to show heart attack rates under the Universal Definition "are not accurate. We asked the BBC to send us this data so we could verify it, but they refused."

Related Video: Study Shows Patients With Stable Chest Pain May Not Need Stents or Surgery (Provided by NBC News)

Do We Really Need Heart Surgeries For Arterial Blockages?

  Do We Really Need Heart Surgeries For Arterial Blockages? A new study found that drug therapy may work as effectively as bypass or stenting procedures in patients with blocked arteries. A new study found that taking drugs alone may offer more benefits, from safety to lower costs. © PixabayResearchers analyzed data from more than 5,000 people who reported moderate to severe blockages in coronary arteries. They said the patients did not not experience any heart attack after taking only drug therapy for blocked arteries unlike those who went under the knife.

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